373. ​​The Art of Routine with Dr. Angel Iscovich

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Dr. Angel Iscovich:

Continuous striving to just change the things you do is not necessarily what your body and your mind really needs, but rather routine.

Dr. Richard Shuster:

Hello and welcome to The Daily Helping with Dr. Richard Shuster, food for the brain, knowledge from the experts, tools to win at life. I'm your host, Dr. Richard. Whoever you are, wherever you're from, and whatever you do, this is the show that is going to help you become the best version of yourself. Each episode you will hear from some of the most amazing, talented, and successful people on the planet who followed their passions and strived to help others. Join our movement to get a million people each day to commit acts of kindness for others. Together, we're going to make the world a better place. Are you ready? Because it's time for your Daily Helping.

Thanks for tuning into this episode of The Daily Helping Podcast. I am your host, Dr. Richard. And I cannot tell you how brilliant our guest is today. Dr. Angel Iscovich, affectionately known worldwide as Dr. I, graduated from the University of California, San Francisco School of Medicine, obtained his postgraduate training in psychiatry, and he practices as an emergency

physician. But his interest in leadership, organizational development, and strategy led Dr. I to C-suite positions in the corporate health sector, as well as chairing Direct Relief, the top rated charity in the U.S.

These experiences afforded Dr. I with a unique view into human behavior and his continual search for meaning and purpose in our lives, which led to the creation of the book, The Art of Routine. We're going to talk about that book today. And he's been everywhere. He's been in countless publications, including Forbes and Entrepreneur. He's been on Dr. Drew. He has been everywhere. And now he's here with us. Dr. I, welcome to The Daily Helping. I've been looking forward to this call for a long time. It is great to have you with us today.

Dr. Angel Iscovich:

Oh, thank you. Thank you. Just great to be there. Thanks for those nice thoughts. Thank you.

Dr. Richard Shuster:

Absolutely. So, when you sent me over your introduction, I viciously used the cut and paste thing, because there's so much of your story that I wanted you to be able to tell that I didn't just want to glance over in a bio. So, tell us about your story. Tell us about your beginnings, and I want to start there.

Dr. Angel Iscovich:

Yeah, surely. I was born in Buenos Aires, Argentina, and I'm actually a true immigrant here, you know, legal immigrant to the United States. And my parents, after World War II, Holocaust survivors, that interestingly enough went to Argentina after the war. There was actually migration of post-war Europe from Italy where they were in refugee camps. But each independently somehow found their way to Argentina, and that's where they met and that's where I was born. And my mother had already family there and that's one of the reasons that she had gone there.

And I kind of grew up in Argentina that's why I've got kind of this unusual name. You know, Angel Leonardo Iscovich which doesn't sound that good in English, but it's Angel Leonardo Iscovich in Spanish. And over my time in in the world both as a physician and later in the corporate world, they just had it abbreviated and called it Dr. I, because they couldn't say the name real well. So, anyway, that's a little bit of my history.

But we immigrated to the United States when I was about 7 or 11 years old. My brother was 11 years old. I was seven. And my parents came with about $100 and two valises because they had a friend that was willing to sponsor us. It was the same dream that you really see immigrants having today in the world. You know, you can look elsewhere, usually they work two jobs, they want to make sure their kids are well educated, and try to as much as they can integrate with community. And so, that was kind of my beginnings.

And I remember that, you know, we learned our multiplication tables and division tables early in Argentina, so I was really good at math, but I couldn't really speak English, but it came fairly quickly. And I was able to kind of begin to integrate and grew up in the Los Angeles area primarily, and now reside in Santa Barbara. So, that's a little bit of that story.

Dr. Richard Shuster:

What did your parents do?

Dr. Angel Iscovich:

My mother, she was from Romania, and she was in Budapest, Hungary when she was young in her early 20s. And she was studying fashion design and she learned how to basically design fashion and basically be a seamstress, a tailor. So to speak, she could do all of those types of things. My father was caught in the middle of the war. He was from Czechoslovakia and he was studying a little bit of business and also learning the art of diamond setting, basically it's kind of a jewelry craft, kind of European diamond setting craft. But they got caught in the middle of the war and just were able to both uniquely survive that terrible time.

And I think when they found each other in Argentina, I think they found difficult times of being able to develop their crafts, both fashion design and diamond setting. And came to the United States with that purpose in mind, and so in the end, my father became - after a little bit of time of getting their feet on the ground - a diamond setter, which is what he did, working both for a company and then for himself. And my mom getting along, trying to make a dollar or two was, really, making dresses and otherwise working out of the home and at one time working. So, it's that kind of real immigrant two job story to get kind of going on their way. And that's pretty much how we grew up.

Dr. Richard Shuster:

And so, you had that entrepreneurial example kind of in front of you, but I'm curious was there something that drew you to medicine when you were young? How did that kind of unfold for you?

Dr. Angel Iscovich:

You know, I participated in sports for quite a bit. I was involved in baseball, and then football, and then tennis, and the sort. And I ended up having a knee injury in high school and had to have a surgery. And during that surgery, I met up with the physician, Dr. Jerry Bornstein, who was an early founder of sports medicine for high schools, for kids, which were really lacking at the time. And through that surgery, he kind of took me under his wing and said you'd like this field once you learn a little bit more about it. And I kind of got interested through that surgery and kind of moved forward from that time on to having an interest. He brought me into the surgical suites to try to observe and that's where my interest first began.

Dr. Richard Shuster:

And yet you kind of have this interesting blend where you spent time in psychiatry, so you're studying human behavior, the human condition, but then you actually were practicing in emergency medicine, which is very different, right?

Dr. Angel Iscovich:

Yeah. It was, you know, I think a little bit for many people, especially when they go on to trying to do professional careers, or they're in college trying to find their way, and even in the middle of one's life trying to find your way of what's meaningful and purposeful, you sometimes don't really know, you're trying things and things maybe meet up with personalities.

One of the aspects I believe is that people have a certain personality. It's a lot of nature and then some of it is nurtured. But it doesn't really change over large periods of times. It either gets accentuated or attenuated. And I think I had a little bit of two sides to me. I was interested in how people interacted, behavior, and the sort. And when I went to medical school, I wasn't quite clear about where my interests lay. So, what I did is I did internal medicine and psychiatry residency and then went on to start in neurology at one of the Harvard programs.

But my father in 1988 had hardship, and the hardship - you might remember, I think it was the Jimmy Carter administration - gold shot way up, so he had no jewelry to actually make because they were really having very little inventory. So, I needed to go to work, actually, and take a moment off of medical school and make a dollar or two to help my dad who helped me get through medical school. And from that, basically, I was able to work emergency departments. And emergency medicine was just becoming a field in the late '70s and early '80s, basically a specialty field. And I ended up kind of realizing that I like the immediate gratification of taking care of someone in an emergency department and then seeing someone else and moving on as opposed to doing longer term care and the sort. So, it started to fit my personality and that's how I got into emergency medicine.

Dr. Richard Shuster:

Perfect. And I know that you spent some time in the C-suite, you moved into the corporate side of health care, you worked for the charity, but I do want to spend a good amount of time about your book. I know it's been very well received everywhere. Tell us why, what was the impetus for writing The Art of Routine?

Dr. Angel Iscovich:

As you know, the fields of medicine have a lot of routine organization and practice in them. When I was running emergency departments, which is what I did, physician management as they call it, we were trying to develop maybe, oh, now, 20 years ago, 15 years ago, geriatric emergency departments. We have pediatric emergency departments. We know that children, for example, are not just little adults. They have their own physiology as they're growing. Well, we learned that also to be the case for people that were, in general, over 65 years of age. That is, you're older, you have very specific needs, you present differently.

So, we're setting up these emergency departments, and as part of that, I got interested in longevity, which I'm still involved with the Center for Aging and Longevity here now at University of California, Santa Barbara, and I studied people that were over 100 years old, centenarians as they're called or centegenarians as some people call them. And I found some interesting aspects about them. One was that they had a very stable environment, both physical, in particular, and emotional. And that they did things with great amount of routines, with great amount of regularity, with great amount of order. They did them very routinely, but what they did in those routines were very different.

For example, we'd ask some of them, "Well, why do you think you've lived such a long life?" They say, "You know, I have a Dr. Pepper very day at 4:00," or others, " I used to walk a mile. I now walk a little less than a quarter mile," and some things were healthy, some weren't. The what varied, but the how, the routine and the stability of their environment didn't.

And that got me to thinking about people that are high performers, that perform at high levels and how do they live their lives and what's the importance of a stable environment and routine for them. It got me thinking about how we care for our children, how we care for our animals, how important routine and a little bit different from habit in the sense is a little more intentional than a habit which is more automated or more rewarded or adverse. And I started to think about even businesses that were really effective and did well in how they were organized and structured, and how they had a certain amount of routine. It got me to thinking that in itself, the how may be more important or as important as the what it is you do.

And in fact, that in our disrupted world, where we have so much to choose from, particularly in our developed countries, and particularly around the time of COVID, which is when I started just prior to COVID to write this book, that when we're disrupted, we become fairly stressed, obviously.

And I started to realize that understanding physiology and medicine and how we care for humans that are diseased or disrupted, I began to understand, really, that the way our bodies work, even at a cellular level, at a molecular level, and on physiological level have a lot of rhythm, a lot of regularity, a lot of routine. And that the way we perceive the world is such that the sun rises and sets. And we like the routine and the routine gives a sense of certainty and meaning and purpose. And then, that there was quite a bit of science and physiology behind what routine does for meaning and purpose.

And when we're disrupted, what we do in medicine and the work, for example, that you've done, and the sort, is we try to create a stable environment. We try to get people on routines, not just on medications that help make the brain chemistry work better or behavior change and the sort.

So, that's kind of was the evolution of the book, and was really an insight into human nature, and trying to speak a little bit to a few stories that highlight that and highlight the how and the where we do this maybe as or more important than the what we do.

Dr. Richard Shuster:

I love this for a lot of reasons, but in particular, habit has become such a buzzword. And we can go back a long time, right? Seven Habits of Highly Successful People by Stephen Covey, or more recently, High Performance Habits by Brendon Burchard. And I own both of those books and they're great books. But there is a difference between habit and routine. And it's the routine that sets homeostasis for us. I mean, it's almost the chicken and the egg thing in some way.

So, I want to dive into that piece because you said there's a physiological component, a biological component to routine, and there's emerging data in that space, so talk to us about the effects of routine on our physiological wellbeing.

Dr. Angel Iscovich:

So, I think without getting overly technical about the neurochemistry or the biochemistry of it, I think the physiology rhythms that we have, the physiology that we have is maybe a better place to work with. We can speak about how doing something over and over again and completing a task makes for better dopamine tracks. It makes you feel better. And it's interesting that just the completion of a task and doing it over and over again gives you a sense of purpose and meaning and completion, which is interesting.

You know, it depends what it is you're doing, but that's the case.

But physiologically, for example, we have rhythms like circadian rhythms. Circadian rhythms are probably the one that I highlight the most a little bit in the book, and more so I think over the last few years the subject has kind of grown a bit, has kind of increased a little bit of the thinking about it. But the body has certain rhythms like circadian rhythms. I speak a little bit to the importance of travel, for example, and how our physiology is very specific about what happens with our cortisol levels throughout the day when we awake.

For example, right now for me, it's not as good a time to engage as it is for you where we have a little time zone differences. But in the mornings, people tend to be able to do very specific tasks, technical tasks. When you get to more like 10:00 to 2:00 is a great time for engagement. I'm speaking in general because people, some are larks and some aren't when they get up. So, there are better times. And we notice what happens when we do time changes when we travel.

And one can even see the importance of these circadian rhythms in performance, for example, an athletic performance, where you'll see that only certain athletes that are touring, they try to control their environment, maintain their routines regardless of the change in times. This is the case for people who travel in business even.

And you see examples of this. The hospitality business is one example where they try to cater to your having a stable environment. So, it's not just about routine. It's about the stability and the familiarity of the environment in spite of the change in time frame. And hospitality business has done that.

I remember telling my CEO or my COO that I worked with, I would say, "You don't have to stay at Courtyard Marriott, and you don't have to take coach seats with Southwest when you travel to all your different facilities and clients." And, "No, no. That's just the way I like it. I know exactly the seat I'm going to take. I know the times that I fly. I know when I get in there. I know exactly the space that I like and what room I'm going to stay." They wanted that type of consistency, a sense of certainty to offset the disruption of their time. That's just one example of circadian rhythms.

You can get into medical physiology, such as gastrocolic reflex, how we have rhythms, such as you eat and then it can motivate your bowel, so to speak. Or postprandial tides where you eat and you can become sleepy after eating. And that changes with age. In the middle years, you're more adaptive to that, and when one is developing and young versus when one is older.

And typical of circadian rhythms is even how it's culturally been the case. For example, the English have tea at 3:00. This is when your cortisol levels go down. This is when you're sleepy. It's not a great time to be productive. The English have tea because it's all controlled by your hypothalamus in your brain, and your cortisol levels drop, you need some form of energy or sugar. Or you need to sleep, which became kind of the Spanish European cultures, that's the concept, it became that way. Or also it controls your sexual drive. The idea of afternoon delight or sex by Italians and the French.

So, you see what happens during that time. Does it become important to know that? Well, I think it does in regard to how you interact and what to do during those periods of times and how you're best able to work through it.

I've spoken to people who are recruiters, people who lead groups, they tell me that we have this meeting at 3:00 and we go through this detail, and it seems like nobody can pay attention and nobody's really alert. And everybody's, of course, grabbing their caffeinated drinks during that period of time. So, there are better times. Those are a little bit of examples of at least physiology that I wanted to give you a little bit about how that impacts what we do when we do it.

Dr. Richard Shuster:

And so, you're talking about physiological neurochemical hardwired responses, but I know your book really dives into, at a core level, behavior, human behavior and how that plays a role in routine. And by consequence, what routine does to human behavior. So, let's talk a little bit about the behavioral side. Let's leave the physiological on the table for a bit.

Dr. Angel Iscovich:

Yeah. So, I think that it's interesting knowing that what's behind that, what occurs. In the book, I speak, for example, a little bit about we interviewed the Rolling Stones manager, and the sort. And you'd think that a group like the Rolling Stones who are septuagenarians - and I think one of them has recently passed away - I think they're close to being octogenarians at 80 years of age, being able to do what they do and perform. And you'd think that it seems unorganized, somewhat creative, off the cuff, maybe changes all the time. But in fact, when you start seeing about how the behavior required for them to perform and to tour at a high level, there are a few interesting things you learn.

Namely, one, that their backstage is exactly the same as it is in every venue that they go to, where the seats are, where things are. This is a little bit of familiarity and certainty in an uncertain world that we all kind of get. And their behavior is able to then improve and develop a routine that is very consistent. They have an exact time when they get into a town and the exact time when they begin to, prior to performance, meet their entourage and do PR, move forward from that PR to warm up, to voice warm up, to dance warm up. Mick Jagger will warm up for approximately a half-hour, then do vocals for another. And it's exactly on time to the moment that they come on stage, let's say it's 7:00 or 9:00.

And so, this is an example of how important, especially when one is older, having a very stable environment can be to how you can perform, namely how one would behave and otherwise.

I think COVID brought on some very interesting kind of disruptive behaviors, suddenly really disrupted people's routines. Suddenly, they were stuck at home. A home that maybe was just a pass through to work, you know, a place to sleep and work, maybe see your family. And suddenly, one is working out of home. Suddenly, one is in this different environment than in the work environment of an office, for example. And this caused quite a bit of disruption, not just in learning how to adapt to it, but suddenly for some, family became important because they were always around you. And instead of the morning hello and the evening how are things going - and obviously this depends on age and the sort - I remember a few people saying, "I couldn't believe that when I saw the couch I had. Why didn't I change out that couch? I can't believe that that sloppy couch was there. Why didn't I change that couch?"

And so, suddenly, the environment that you were in became very important in how you interacted. And what started to happen in regard to family time, so to speak, kitchen table time, we started to adjust how and when we worked, I think was an interesting kind of study on human behavior, human adaptability and the importance of the environment and developing new routines as opposed to what one was doing before getting up in the morning and then moving through the day. Those are a few examples.

Dr. Richard Shuster:

So, we live in a world that is incredibly dynamic. We are exposed to a 24-hour customized information cycles on our smart devices. Artificial intelligence is now something that we are starting to reckon with. More so I think in the corporate space, although there's absolutely going to be bleed over into our personal lives, tell us about where you see routine and how that all is essential for our species really moving forward.

Dr. Angel Iscovich:

Well, if you look historically and we say that it's our nature and that we're kind of physiologically in a cellular level trying to always maintain homeostasis and maintain equilibrium, one of the things that one sees as one studies human and social behavior over time, is you see that to survive disruptive events, pestilence, wars, so forth and so on, you see people moving or groups of people moving and migrating. You know, just like we see today in many parts of the world, to find what we call a better life.

Because it was interesting, they asked a number of people during the World War II, for example, in England, where they're constantly under sirens, going underground to protect themselves, they say, "What is it that you want?" "All I want is an everyday life. That's really what I want is an everyday life. I want to be able to just have a form of a routine. I don't like all of the disruption."

So, to your point, we're being bombarded with information. We have so many sources of information that come to us that we're picking a lot of the what to do, as opposed to trying to get into a routine, do something and stick with it for a period of time.

I see this all the time, for example - and I'll speak a little bit in technology in a second - we see this often now where this disruption you're seeing time on online, for example. You're seeing these issues. What is it in Florida now? They're not going to let children have cellphones in high schools and junior high schools. And so, you're seeing a little bit of how technology is giving us so much information that it's disrupting and not allowing us to stick with one thing. It's being very distractive and, what we would call, multitask. Though, I think the brain doesn't really multitask according to studies that I've seen. You may know better about that than I do from what I've seen.

So, technology is very disruptive. On the other hand, it can be also fairly organizing the routine. Actually, a little bit about artificial intelligence and machine, learning game theory, I chair a company called Potentia Analytics in healthcare. And consequently in charing that company, I've had to learn more about, you know, artificial intelligence and where it's going and where it benefits us. And I think you start to have moral questions about where does it benefit us, where can we develop routines. It's interesting that the term routine is part of artificial intelligence coding and artificial intelligence algorithms.

Because, really, when you think about this, I mean, artificial intelligence isn't some other thing. It's just created by us. It's just a reflection of us. It's what we've created. And maybe it can compute a little faster or do things. People keep thinking of it as something like an alien that came down into the world, but it's actually about us. So, it's about how do we use technology that we've developed to not just be disruptive, but rather to develop good routines and develop some other benefits to our survival to give us meaning and purpose.

And it's a term actually in the investment world called tech manatee, the intersection between technology and humanity. It originally was developed as a term for investing into companies that are going to be forwarding age, longevity, and technology. So, the things that really make this change were the companies that were in big data, in genomics, for example, in our genetic ability, and the sort. So, that's how tech manatee kind of started, but it's a pretty good term for how we come to that intersection and how we're able to kind of deal with it in routines.

You know, for example, people ask me, "Well, I can't get into any routine. Dr. I, can you give us a thought of how we can use technology in a good way versus a bad way?" And a simple example was, if you need to get into a routine, I kind of liked daily affirmations, for example. I said, "Look, get your cell phone, get on the calendar, set up a 7:00 repeating in the morning piece and say daily affirmation." And I don't really care what the what of the daily affirmation is. What's more important to me is that you do it every day. It could be how the day is going to go. It could be the old Stuart Smalley, you know, "I'm good enough, I'm smart enough, and doggone it, people like me."

Dr. Richard Shuster:

"I'm good enough, I'm smart enough, and doggone it, people like me."

Dr. Angel Iscovich:

Yeah. Remember that? And he'd say that every morning. And some of these types of routines kind of become rituals, and rituals become traditions.

And you see this, of course, in religion. A lot of this like evening prayer that we would maybe pursue in the Christian-Judeo world has a lot to do with kind of ending the day and then beginning. And so, in itself, just doing a daily affirmation or an evening or both, but you can use technology to help guide you.

And you're starting to see this now, for example, with smart watches that kind of tell you, you haven't stood up enough for long enough. It's using AI to determine that and the sort. So, there's a lot of really good uses of artificial intelligence. But I think that that interface of tech manatee now is going to have some dangerous applications because, just like we can have good routines, we can have bad routines and we can do things that are really addictive that have physiological addiction as well that aren't really necessarily the things to do on a regular basis, but are required by the body, so to speak.

So, maybe a little too avert, but I think there's a lot there in the future and some real practicality at the importance of trying to organize and structure one's life a bit more. Try to choose something that's kind of The Art of Routine, choosing what it is you want to do. But instead of saying I'm going to start an exercise routine, or something like that, I did Pilates and then I went to yoga, start with something and stick to it. Get in a routine, get adapted. And then, if not, you can change that. There's nothing wrong with the change of the what. But I think we need to be more cognizant of that type of work.

You know, there's a lot of studies regarding routine and meeting. I remember talking to my friend, Angel Martinez. I don't know, this is a little side note just to talk to you. But Angel Martinez was the CEO of Deckers, and I write in the book about him because he, like myself, instead of being a Argentine immigrant to the United States, he was a Cuban immigrant out of the United States, where his parents sent him to their uncle during the revolution. And he ended up being a runner and using the running routine and all of its benefits to help him organize and give him a sense of structure and importance, to the point that it helped him develop his skillsets, his ability to be able to lead companies, and ended up leading Reebok, and then becoming part of Deckers, the boots and the sort.

And so, he's a story in itself of the running routine, for example, what it did for him in trying to organize a fairly disrupted life.

But I remember speaking to him about the person in Indonesia that is maybe making some of these shoes, and doesn't have much of an education. But what they're doing is maybe tying the laces at the very end before they go into the shoes. And they're doing this repetitively throughout the day, completing it and beginning to work at this time and that time. And that's making a living to help support their family. And one would say, "My goodness, that just doesn't seem like a great life. My goodness, that seems boring and the sort." But for that person, this makes for lots of meaning, lots of purpose in developing a routine and their ability to continue.

So, just a little side note I wanted to give you above and beyond technology.

Dr. Richard Shuster:

I'm glad you did. Dr. I, I could talk to you for hours and we'll have to have you back to dive deeper. But we are at time, and speaking of routines, as you know, I ask every guest a single question at the end of the show, and that is, what is your biggest helping? That one most important piece of information you'd like somebody to walk away with after hearing our conversation today.

Dr. Angel Iscovich:

That continuous striving to just change the things you do is not necessarily what your body and your mind really needs, but rather routine.

Dr. Richard Shuster:

Short and sweet. I love it. Dr. I, tell us where people can learn more about you online.

Dr. Angel Iscovich:

Well, you know, I've got my different handles. You can just Google angeliscovitch.com, if you can spell it, or just look for Dr. I and the sort. And, you know, I've been pursuing a few other aspects related to this piece, but you're welcome if you'd like to get a copy of the book, The Art of Routine. It might kind of stimulate some of this thought and how it might relate to your own personal life.

Dr. Richard Shuster:

Perfect. And we will have links to everything Dr. I in the show notes at drrichardschuster.com. Well, again, Dr. I, I have loved our time together. This flew by and was such a great and thought provoking conversation. Thanks for coming on The Daily Helping today.

Dr. Angel Iscovich:

Thank you, Dr. Richard. It was a pleasure.

Dr. Richard Shuster:

Absolutely. And I want to thank each and every one of you who took time out of your day to listen to this. Why don't you make it part of your routine? Go listen to our show. But most importantly, go give us a follow and a five star review on Apple Podcast or your podcast app of choice, because this is what helps other people find the show. And also, go out there today and do something nice for somebody else, even if you don't know who they are, and post it in your social media feeds using the hashtag #MyDailyHelping, because the happiest people are those that help others.